Would You Recommend Intacs for a 27 Year Old Patient With Early Keratoconus?

I have a 27 year old patient with early keratoconus, with about 6 diopters of cylinder, best corrected with glasses to about 20/25. His K’s have been stable for a year. He wanted to know about Intacs- I told him that the results are pretty good, reversible if necessary so no bridges are burned, and a better option than PKP if PKP can be avoided. He also asked about the new riboflavin cross-linking for ectasia. I heard a lecture about that on AudioDigest- the preliminary results sound promising. I was hoping to hear from cornea surgeons about their experience with Intacs for kerataconus, and if they have more information about the new cross-linking treatment.

Comments

Please consult with Dr. Brian Boxer-Wachler he knows everything there is to know about Corneal Cross-Linking and Intacs.

Dr. Weitzner

on February 28, 2009 8:56 pm

thanks so much dr. swanson- i will be sure to encourage my patient to pursue intacs when he becomes a little more symptomatic- he is very satisfied with his vision presently. good to hear that many like him will be able to avoid or postpone pkp- although it’s a nice procedure, considering the prolonged recovery, induced cylinder, and predicted viability of about 10-15 years, i think it’s past time for it to be replaced with something better! dlek and related procedures seems to be the way to go…

The results with INTACS are very good. INTACS have treated ectatic corneas since 1997. The first cases were performed by Prof. Joseph Colin from France. We have treated patients since 2000 and have over 8 years follow up with stable results.

Internationally, we are able to treat most of the 6 diopters of astigmatism with INTACSSK. Also we are treating as high as 10+ diopters of spherical equivalent. If you treat the patient with INTACS 7.0mm you will most likely treat 70 to 80% of the cylinder.

We have treated over 300 corneas with corneal crosslinking. We presented 200 eyes results about 2 years ago. The results with crosslinking show promised; however, in our experience we recommend INTACS as the first step in the treatment of unstable cornea and then proceed with crosslinking to improve the INTACS results by 1 to 2 lines of vision. Crosslinking may not have effect along in 30% of patients.

For ASCRS:
Modified implantation of INTACS inserts for the treatment of keratoconus and
iatrogenic keratectasia
Mark Swanson, MD
Purpose: To evaluate a modified technique for implantation of intrastromal inserts
(INTACS) for the treatment of keratoconus and iatrogenic keratectasia.
Methods: Prospective study on 96 eyes selected for keratoconus (forme fruste, incipient
mild and severe forms), and ectasia following LASIK, hexagonal keratotomy, radial
keratotomy, or astigmatic keratotomy. Patients were excluded for central corneal
scarring, hydrops, and severe thinning of the cornea (300 microns or less). Patients were
followed for one year. The modified technique places intrastromal inserts on opposite
sides of the conus, displacing the thinnest area toward the center and thereby creating a
more regular and smooth corneal surface.
Results: UCVA improved to 20/40 or better in 100% of the mild cases and 55% in the
moderate to severe cases. BCVA improved to 20/30 or better in 100% of the mild cases,
90% of the moderate cases and 62% of the severe cases.
Conclusion: The modified technique markedly improved vision and eliminated or
reduced monocular diplopia sometimes observed with horizontal placement of the inserts.
Mark Swanson, MD
Anterior segment and refractive surgery practice, Swann Instituto, Agua Prieta Sonora
México and Douglas, AZ, USA
Mark Swanson, M.D.
Douglas, AZ 85607-3101
Telephone: 520-204-1353